Register for the Family Leadership Conference

Registration Form

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Name*

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Phone*

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How many adults are you registering:*

Please enter a number from 1 to 10.

Adult 2:*

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Adult 3:*

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Adult 4:*

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Adult 5:*

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Adult 6:*

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Adult 7:*

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Adult 8:*

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Adult 9:*

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Adult 10:*

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How many youth (age 13-18) or students are you registering?*

Please enter a number from 0 to 5.

Youth 1*

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Date of Birth*

Youth 2*

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Date of Birth*

Youth 3*

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Youth 4*

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Youth 5*

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How many children (0-12 years old) are you registering?*

Please enter a number from 0 to 6.

Child 1*

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Date of Birth*

Child 2*

First Last

Date of Birth*

Child 3*

First Last

Date of Birth*

Child 4*

First Last

Date of Birth*

Child 5*

First Last

Date of Birth*

Child 6*

First Last

Date of Birth*

Would you like more information on our Pre-Conference Leadership Academy happening on May 12th?

Are you interested in staying at the hotel? Would you like more information on discounted room rates?

Pick Your Ticket(s):

Adult (Self Advocate/Family Member) Ticket:

Price: $50.00

Professional Ticket:

Price: $200.00

Youth/Student (14-26) Ticket:

Price: $35.00

Child (0-13) Ticket:

Price: $25.00

Total

Consent*

I understand by attending this event, I consent to be photographed, filmed, and/or otherwise recorded. I further consent to PRO's use of my likeness, without my name or other identifying information included, in any and all recorded media for use in digital and/or printed materials that may be reproduced, published, and/or exhibited for purposes including marketing, promotion, fundraising, and supporting the mission of PRO. If you have any questions, please contact us at 505-247-0192 or conference@parentsreachingout.org

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Attending the Family Leadership Conference

Register for the Family Leadership Conference

Registration Form

Pick Your Ticket(s):

Early Childhood

Education

Healthcare

Family Leadership

Register for the Family Leadership Conference

Registration Form

Pick Your Ticket(s):

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Early Childhood

Education

Healthcare

Family Leadership